ADDRESS
BY

C, Everett Koop, M.D., Sc.D,
SURGEON GENERAL
OF THE
U.S. PuBLic HEALTH SERVICE
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

A

PRESENTED AT THE 40TH SCIENTIFIC ASSEMBLY OF THE
AMERICAN ACADEMY OF FAMILY PHYSICIANS
New ORLEANS, LOUISIANA
OcToBER 3, 1988
1
(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC.)

I’M DELIGHTED TO JOIN YOU AT THIS, YOUR 40TH SCIENTIFIC
ASSEMBLY, AND TO SEE SO MANY GOOD FRIENDS ONCE AGAIN.

~T HAVE ALWAYS RESERVED THE GREATEST RESPECT FOR THE
DISCIPLINE OF FAMILY MEDICINE AND I’VE BEEN VERY PLEASED TO NOTE
THAT IT HAS BEEN CONSIDERED A VITAL DISCIPLINE WORTHY OF
CONTINUED FEDERAL SUPPORT THROUGHOUT THESE YEARS OF TIGHT FEDERAL
BUDGETS.

OF COURSE, I ALSO VALUE THE FRIENDSHIP AND SUPPORT OF THIS
ORGANIZATION. THE ACADEMY HAS STOOD BY ME IN MANY OF THE TOUGH
ISSUES OF THE PAST 7 YEARS, INCLUDING SMOKING, DRUNK DRIVING, AND
FAMILY VIOLENCE.

I‘D LIKE TO GIVE SPECIAL RECOGNITION TO THREE OF YOUR
COLLEAGUES, DRS. ALAN BLUM, JOHN R. “RICK” RICHARDS, AND TOM
HOUSTON, THE ORGANIZERS OF “DOCTORS OUGHT TO CARE,” OR “DOC,”
THEY ARE AN ACTIVE AND CONCERNED GROUP -- ALBEIT UNORTHODOX AT
TIMES -- WHO HAVE BEEN OUTSTANDING IN THEIR SUPPORT FOR THE
NATIONAL CAMPAIGN AGAINST SMOKING.
FOR THEIR UNSTINTING EFFORTS, I WAS PLEASED TO HAVE AWARDED
DRS. BLUM, RICHARDS, AND HOUSTON THE “SURGEON GENERAL’S
MEDALLION” JUST BEFORE COMING ON TO THE PLATFORM.

AND DURING THE PAST WEEK MY STAFF HAS CONTACTED YOUR
DIRECTOR OF EDUCATION, DR. JANE MURRAY, RELATIVE TO THE
PUBLICATION NEXT MONTH OF MY “SURGEON GENERAL’S LETTER ON CHILD
SEXUAL ABUSE.” I BELIEVE THIS COULD BE A VERY HELPFUL BROCHURE
FOR EVERY FAMILY PHYSICIAN WHO MAY SUDDENLY FIND HIMSELF OR
HERSELF CARING FOR A CHILD WHO HAS BEEN SEXUALLY ABUSED OR
ASSAULTED OR IN SOME OTHER WAY SEXUALLY VICTIMIZED,

I WAS ASKED BY THE DEPARTMENT OF JUSTICE TO PREPARE SUCH A
BOOKLET FOR HEALTH PROFESSIONALS SO THAT OUR TWO DISCIPLINES OF
LAW AND MEDICINE COULD WORK BETTER TOGETHER ON THIS VERY PAINFUL
PUBLIC ISSUE.

WE REALLY NEED YOUR HELP ON THAT ONE, AND I’M DELIGHTED TO
KNOW THAT WE‘LL BE WORKING TOGETHER ON IT,
OF COURSE, WE ALWAYS WORK TOGETHER ON THE TOUGH ISSUES. THE
EASY ONES WE CAN HANDLE OURSELVES. BUT TODAY I WANT TO DISCUSS A
PROBLEM THAT MAY BE THE MOST DIFFICULT ONE WE’VE EVERY FACED.

I’M TALKING ABOUT AIDS. AND I SINCERELY APPRECIATE DR. BOB
GRAHAM’S INVITATION TO ME TO COME HERE TO NEW ORLEANS AND SHARE
WITH YOU SOME OF THE THINGS I’VE LEARNED LATELY ABOUT THAT
COMPLEX AND HIGHLY DANGEROUS DISEASE.

FIRST, A WORD ABOUT BOB GRAHAM. THOSE OF YOU WITH LONG
MEMORIES WILL RECALL THAT I HAVE NOT ALWAYS ENJOYED MY PRESENT
ACCEPTANCE IN WASHINGTON, IN THE COUNTRY, AND IN THE PRESS.
DURING THOSE EARLIER AND VERY TRYING DAYS, DR. GRAHAM WAS A REAL
SOURCE OF ENCOURAGEMENT TO ME. THE FEW FRIENDS OF THOSE EARLY
DAYS WILL ALWAYS HAVE A SPECIAL PLACE IN MY AFFECTION.

NOW, BACK TO AIDS.
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I WON’T GO INTO ANY SCIENTIFIC DETAIL BECAUSE WE HAVE PEOPLE

WHO ARE FAR MORE KNOWLEDGEABLE THAN I WHO CAN DO THAT FOR YOU:
DRS. ROBERT GALLO AND ANTHONY FAUCI AND PETER FISCHINGER, FOR
EXAMPLE,

INSTEAD, I’D LIKE TO OFFER YOU A QUICK UPDATE AS TO WHERE WE
ARE IN OUR OVERALL KNOWLEDGE OF AIDS AND WHAT WE’RE DOING ABOUT
IT AND THEN GO ON TO SUGGEST WHAT ALL THIS MIGHT MEAN FOR THE
PRACTICING FAMILY PHYSICIAN,

THE FIRST THING TO KNOW IS THAT THE AIDS VIRUS IS STILL
SPREADING, BOTH IN OUR COUNTRY AND WORLDWIDE. THAT’S THE PREMISE
FOR EVERYTHING WE DO. WE'VE GOT A KILLER DISEASE ON OUR HANDS
AND IT'S REACHING FARTHER AND DEEPER INTO OUR SOCIETY EVERY DAY,

OUR STATISTICIANS PREDICTED TWO YEARS AGO THAT THE AIDS
EPIDEMIC WOULD CONTINUE TO GROW AND SPREAD WELL IN TO THE 1990°S
1+» AND I‘M AFRAID THEY WERE RIGHT,
5
FOR EXAMPLE, IN THE SINGLE YEAR BETWEEN SEPTEMBER 1987 AND

AUGUST 1988 WE LOGGED IN ALMOST 31,000 NEW CASES HERE IN THE
UNITED STATES,

~ SINCE THE FIRST 5 CASES WERE RECORDED IN LOS ANGELES BACK IN
1981, THAT CITY HAS REPORTED ANOTHER 5,460 CASES ... AND THE
COUNTRY AS A WHOLE HAS TURNED UP A TOTAL OF ALMOST 75,000 CASES
OF AIDS,

I SAY “THE COUNTRY AS A WHOLE” BECAUSE BY NOW EVERY STATE
AND TERRITORY OF THE UNITED STATES HAS BEEN TOUCHED BY THIS
EPIDEMIC,

T DON’T KNOW WHERE EACH OF YOU PRACTICE, BUT IT DOESN'T
MATTER ANY MORE, BECAUSE WHEREVER YOUR OFFICE MAY BE, I’LL WAGER
THAT YOU’RE NOT MORE THAN A COUPLE OF HUNDRED MILES AT THE MOST
-- OR A COUPLE OF HUNDRED EEET AT THE LEAST -- FROM SOMEONE WITH
AIDS.

 
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MIND YOU, NOT JUST SOMEONE WHO TESTS SEROPOSITIVE FOR THE

VIRUS, BUT SOMEONE WHO ACTUALLY HAS A REPORTABLE AIDS-RELATED
DISEASE OF SOME KIND.

THAT’S THE SITUATION IN THE UNITED STATES ... AND IT’S
BECOMING THE SITUATION WORLDWIDE AS WELL. SOME 140 COUNTRIES, IN
ADDITION TO THE U.S.A., HAVE REPORTED 40,000 CASES OF AIDS SO
FAR,

OF COURSE, WE ALL KNOW THAT MANY COUNTRIES DON’T YET HAVE
GOOD SYSTEMS FOR GATHERING AND ANALYZING EPIDEMIOLOGICAL DATA ...
CERTAINLY NOT AS GOOD AS OURS.

THIS IS ESPECIALLY TRUE AMONG THE THIRD WORLD COUNTRIES OF
ASIA AND AFRICA, WHERE -- UNFORTUNATELY -- THE DISEASE SEEMS TO
BE THE MOST VIRULENT.

HENCE, THE WORLD HEALTH ORGANIZATION ESTIMATES THAT BARELY
HALF OF THE TRUE AIDS CASELOAD WORLDWIDE HAS BEEN REPORTED,
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BUT THE CONTINUED EXPANSION OF THE AIDS EPIDEMIC IS ONLY
PART OF THE STORY. THE OTHER PART IS EVEN MORE GRIM: AIDS IS
VIRTUALLY 100 PERCENT FATAL. OF THOSE 75,000 AMERICANS WHO WERE
REPORTED AS HAVING AIDS SO FAR, 42,000 HAVE DIED.

| THAT’S AN OVERALL MORTALITY RATE OF 56 PERCENT.

BUT LET’S LOOK AT THOSE FIGURES MORE CLOSELY. OF THE NUMBER
OF PEOPLE WITH AIDS IN 1981, SOME 92 PERCENT HAVE ALREADY DIED.

OF THOSE IN 1982, CLOSE TO 90 PERCENT HAVE DIED,

AND ALMOST HALF THE NUMBER OF PEOPLE WHO WERE REPORTED WITH
AIDS JUST LAST YEAR HAVE ALREADY DIED.

SO, EVEN THOUGH WE DON’T KNOW EVERYTHING ABOUT THIS DISEASE,
WE DO KNOW ONE THING FOR CERTAIN:

IF YOU HAVE AIDS, YOUR CHANCES OF SURVIVING THE NEXT TWO OR
THREE YEARS ARE NOT VERY GOOD. BUT YOUR CHANCES OF
SURVIVING ANY LONGER THAN THAT ARE ALMOST NIL,
ALL RIGHT, WHAT ARE WE DOING ABOUT IT?

FIRST OF ALL, WE'RE MOVING AHEAD ON VACCINE DEVELOPMENT,
AND, IN FACT, RIGHT NOW WE HAVE TWO VACCINE MODELS GOING THROUGH
THE VERY EARLIEST PHASES OF CLINICAL TESTING.

BUT THOSE ARE ONLY THE FIRST TINY STEPS IN VACCINE DEVELOP-
MENT. MY FRIENDS, IT’S GOING TO BE A VERY LONG PROCESS --
STRETCHING TO THE END OF THIS CENTURY AT_THE VERY LEAST -- BEFORE
WE COME UP WITH A SAFE, EFFECTIVE, AND READILY AVAILABLE VACCINE
AGAINST AIDS. AND HONESTLY, I'M TRYING TO BE OPTIMISTIC ABOUT
IT,

NOW, IT’S TRUE THAT WE HAVE A DRUG CALLED A.Z.T. WHICH SEEMS
ABLE TO PROLONG THE LIVES OF MANY PERSONS WITH AIDS. AND SEVERAL
OTHER DRUGS WITH THE SAME KIND OF PROMISE ARE IN THE PIPELINE.

BUT THESE DRUGS ONLY PROLONG A PERSON’S LIFE FOR A FEW
MONTHS ... MAYBE A YEAR ... IF THEY WORK. THEY DON’T CURE
ANYONE OF AIDS ... NOR OF ANY CONDITION BROUGHT ON BY AIDS,
THE HARD TRUTH IS STILL THIS: WE HAVE NO DRUG ... NO
yACCINE .». NO “MAGIC BULLET” OF ANY KIND TO PREVENT AIDS OR

STOP IT IN ITS TRACKS.

BUT WE’RE NOT AT A TOTAL LOSS ON THIS DISEASE, AS YOU ALL
WELL KNOW, I’M SURE. WE DO KNOW THAT THE VIRUS IS TRANSMITTED BY
VARIOUS KINDS OF HUMAN BEHAVIOR. AND, THEREFORE, WE KNOW THAT
EDUCATION TO CHANGE THOSE KINDS OF BEHAVIOR IS CURRENTLY OUR ONLY
WEAPON AGAINST THIS DISEASE,

AND THIS IS PRECISELY THE JOB FOR WHICH PHYSICIANS ARE THE
MOST QUALIFIED, SHOULD YOU WAIT AND TELL YOUR PATIENTS ABOUT
AIDS ONLY AFTER THEY SHOW UP SEROPOSITIVE OF WITH THE SIGNS OF AN
AIDS-RELATED DISEASE?

OF COURSE NOT. THE TIME TO TELL THE AIDS STORY IS AT THE
FIRST OPPORTUNITY YOU HAVE. TELL THE FACTS 10 YOUR ADULT
PATIENTS -- MEN AND WOMEN -- AND TO THE YOUNG PEOPLE WHO COME
INTO YOUR CIRCLE OF CARE,
10

AND I WOULD ADD, “ESPECIALLY THE YOUNG PEOPLE.”

AIDS IS TRANSMITTED FOUR WAYS ... AND ONLY FOUR WAYS:

* PRIMARILY THROUGH SEXUAL INTERCOURSE ... MOSTLY BUT
NOT EXCLUSIVELY ANAL INTERCOURSE ENGAGED IN MOST FREQUENTLY
BY HOMOSEXUALS AND BISEXUAL MALES. THIS ACCOUNTS FOR ABOUT
TWO-THIRD OF ALL CASES OF AIDS.

BUT PLEASE REMEMBER THAT HOMOSEXUALITY ... BY ITSELF ..,
DOES NOT CAUSE AIDS, JUST AS HETEROSEXUALITY ... BY ITSELF
.+ DOES NOT CAUSE SYPHILIS.

* AIDS IS ALSO TRANSMITTED THROUGH THE BLOOD OF
INTRAVENOUS DRUG ADDICTS WHO USE THE NEEDLES AND SYRINGES OF

OTHER ADDICTS ALREADY INFECTED WITH AIDS VIRUS

* THE VIRUS IS ALSO PASSED ON FROM AN AIDS-INFECTED
MOTHER TO HER INFANT DURING PREGNANCY OR AT THE TIME OF
DELIVERY
11

* AND, TO A VERY LIMITED EXTENT, THROUGH TRANSFUSED BLOOD
OR BLOOD PRODUCTS. BUT THIS DANGER IS NOW ALMOST
STATISTICALLY INSIGNIFICANT,

THE ODDS TODAY OF GETTING A CONTAMINATED UNIT OF TRANSFUSED
BLOOD ARE BETWEEN 1 IN 40,000 AND 1 IN 250,000, COMPARE
THAT WITH, SAY, DEATH ON THE HIGHWAY, WHERE THE ODDS AGAINST
YOU ARE ONLY 1 IN 5,900,

RIGHT NOW, THEREFORE, THE GREAT MAJORITY OF CASES -- ABOUT
9 OF EVERY 10 -- INVOLVE HOMOSEXUALS OR BISEXUAL MALES OR DRUG
ABUSERS. IN OTHER WORDS, IF THESE TWO GROUPS SUDDENLY CHANGED
THEIR HIGH-RISK BEHAVIOR, THE SOCIAL IMPACT OF THIS DISEASE
WOULD EVENTUALLY PLUNGE BY 90 PERCENT.

I SAY “EVENTUALLY” BECAUSE OF THE LONG INCUBATION PERIOD AND
THE FACT THAT THOSE PEOPLE CARRYING THE VIRUS -- PERHAPS ABOUT
1.5 MILLION PEOPLE -- STILL HAVE TO GO THROUGH THE COURSE OF THE
DISEASE.
12

CLEARLY, FROM A PUBLIC HEALTH AND EPIDEMIOLOGICAL VIEWPOINT,
THIS IS WHERE WE NEED TO SPEND MOST OF OUR TIME AND EDUCATIONAL
ENERGY.

BUT IT’S A BIG JOB BECAUSE -- UNFORTUNATELY -- A GREAT MANY
OF OUR YOUNG PEOPLE OF ALL SOCIAL AND ECONOMIC CLASSES AND OF
ALL RACES AND ETHNIC BACKGROUNDS BEGIN TO EXPERIMENT WITH SEX
AND WITH DRUGS IN THEIR EARLY ADOLESCENT YEARS AND ON INTO THEIR
20s. AND MUCH OF THIS EXPERIMENTATION CAN LEAVE THEM VULNERABLE
TO INFECTION BY THE AIDS VIRUS.

FOR EXAMPLE, ONE OF THE MORE SOBERING BITS OF INFORMATION
I‘VE RECEIVED THIS YEAR IS THE EXTENT TO WHICH YOUNG PEOPLE AWAY
AT COLLEGE RECKLESSLY EXPERIMENT WITH SEX AND DRUGS -- AND,
HENCE, WITH THEIR VERY LIVES -- AS SOON AS THEY’RE OUT FROM UNDER
THE CLOSE OBSERVATION OF THEIR PARENTS.

THAT'S NEVER BEEN A COMFORTING THOUGHT, BUT TODAY IT’S EVEN
MORE DISCOMFORTING BECAUSE WE KNOW FOR A FACT THAT SUCH BEHAVIOR
PUTS THEIR LIVES ON THE LINE.
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I] BELIEVE IT MUST BE THE GOAL OF EVERY FAMILY PHYSICIAN TO
GET THAT MESSAGE ACROSS TO OUR YOUNG PEOPLE, AS THEY PREPARE 10
LEAVE HOME FOR THE WIDE WORLD OF HIGHER EDUCATION.

YES, THEY SHOULD HAVE BEEN REACHED WELL BEFORE NOW -- IN
ELEMENTARY OR JUNIOR HIGH SCHOOLS AND SURELY BY THEIR PARENTS,
BUT THAT HASN‘T BEEN THE CASE FOR TENS OF THOUSANDS OF YOUNG
PEOPLE. AND WE HAVE NO PROFESSIONAL RIGHT TO STAND BACK, POINT
THE FINGER OF BLAME AT OTHERS ... AND THEN DO NOTHING,

IF YOU MISSED A FEW YOUNGSTERS WHO’VE ALREADY LEFT FOR THEIR
RESPECTIVE CAMPUSES, TRY AND SET UP A BRIEF CONSULTATION WITH
THEM FOR THE MID-TERM OR MID-YEAR HOLIDAY BREAK, WHEN THEY MAY
COME BACK TO TOWN FOR A VISIT.

IF I’M PROJECTING A NOTE OF URGENCY IN MY VOICE, IT’S
BECAUSE THAT’S EXACTLY WHAT I FEEL,
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I‘M WORRIED ABOUT HAVING THE LIFE-SAVING FACTS ARRIVE ONE

DAY OR EVEN ONE HOUR TOO LATE FOR A TEENAGER WHO MAY GO ON TO
BECOME INFECTED WITH THE AIDS VIRUS ... AND VERY LIKELY, IN HIS
OR HER IGNORANCE, GO ON TO INFECT OTHERS AS WELL.

WE MUST STOP THIS MULTIPLIER EFFECT. AND WE HAVE NO WAY OF
DOING IT OTHER THAN THROUGH EDUCATION,

AND THE MOST EFFECTIVE EDUCATION WE HAVE IS THE KIND OF
EDUCATION THAT KNOWLEDGEABLE, CONCERNED PHYSICIANS -- MEN AND
WOMEN JUST LIKE YOURSELVES -- ARE ABLE TO PASS ON TO THEIR
PATIENTS.

FOR THOSE OF YOU WHO MAY STILL FEEL A LITTLE TREPIDATION
ABOUT GETTING INVOLVED WITH THIS KIND OF INFORMATION, LET ME
ASSURE THAT IT’S PROBABLY THE EASIER OF THE TASKS YOU COULD --
AND SHOULD -- ASSUME.
15
THE SECOND TASK I WANT TO MENTION TODAY -- THE TASK OF

ACCEPTING THE AIDS PATIENT AND DEALING WITH THAT PERSON IN A
PROFESSIONAL AND COMPASSIONATE MANNER -- PRESENTS OTHER AND MORE
COMPLEX CHALLENGES,

I THINK IT’S FOOLISH NOT TO REALIZE THAT AIDS IS AS
FRIGHTENING TO THE INDIVIDUAL PHYSICIAN AS IT IS TO ANYONE ELSE,
AS I’VE ALREADY INDICATED, NO ONE IN MEDICINE HAS QUICKER ACCESS
TO A CURE, IN CASE OF INFECTION ... BECAUSE THERE IS NO CURE.

NOW, ALL THOSE YEARS OF THE RHETORIC OF DEDICATION ... OF
THE REPETITION OF THE HIPPOCRATIC OATH ... OF GRAND SPEECHES
BEFORE THOUSANDS OF BANQUETS AND LUNCHES ... ALL THAT ORAL
HISTORY HAS BEEN CONSCIENTIOUSLY WRITTEN AND DELIVERED BY US AND
OUR COLLEAGUES THROUGHOUT MEDICINE. I DON’T QUESTION THAT AT
ALL.

BUT NOW WE‘RE FACED WITH A DISEASE THAT IS TESTING OUR
COMMITMENT TO THOSE PRINCIPLES OF MEDICINE AND HEALTH CARE WE'VE
BEEN ESPOUSING ALL OUR PROFESSIONAL LIVES.
16

THIS HAPPENS AT OTHER TIMES IN OUR CAREERS, AMERICAN FAMILY
PHYSICIANS HAVE SERVED OVERSEAS IN WAR ZONES ... IN THE MIDST OF
-- AND IN THE AFTERMATH OF -- REVOLUTIONS AND MAJOR NATURAL
CATASTROPHES ... IN THE INFESTED BACKWATERS OF THIRD WORLD
COUNTRIES ... WE’RE NOT STRANGERS TO SICKNESS AND DEATH,

BUT AIDS HERE IN THE UNITED STATES IS A LITTLE DIFFERENT.
IT MAY PRESENT ITSELF IN THE FORM OF A PATIENT, A FAMILY MAN IN
HIS LATE 30s, SOMEONE YOU‘VE KNOWN -- OR THOUGHT YOU HAD KNOWN --
FOR THE PAST SEVERAL YEARS, A MAN WHO IS SHOWING ONE OR ANOTHER
PHYSICAL OR MENTAL SYMPTOMS OF AN AIDS-RELATED ILLNESS.

YES, OF COURSE, YOU MUST CONTINUE TO TREAT HIM AS YOUR
PATIENT. AND, YES, OF COURSE, YOU MUST EXERCISE SOME CAUTION
WHEN COLLECTING HIS BODY FLUIDS -- BLOOD OR PERHAPS SEMEN, FOR
EXAMPLE -- FOR THE LAB,

AND, YES, OF COURSE, YOU MUST TELL HIM WHAT YOU SUSPECT AND,
IF HE NEEDS HELP IN DEALING WITH THAT INFORMATION, YOU MUST
ENGAGE IN A CONFIDENTIAL STRATEGY TO GET HIM THAT HELP.
17
AND, YES, OF COURSE, YOU HAVE TO WEIGH YOUR RESPECT FOR HIS

PRIVACY AGAINST THE RESPONSIBILITY YOU MAY HAVE TO GET THIS LIFE-
THREATENING INFORMATION TO HIS WIFE, FOR EXAMPLE, AND TO HIS
OTHER SEXUAL CONTACTS, IF THERE ARE ANY -- AND TO DO THIS WITH
HIS HELP, IF AT ALL POSSIBLE ... OR WITHOUT HIS HELP, IF THE
LIVES OF THESE OTHER SEXUAL PARTNERS ARE AT STAKE.

THIS IS DIFFERENT FROM PERFORMING TRIAGE AT THE SITE OF A
LANDSLIDE IN THE ITALIAN ALPS OR PROVIDING RUDIMENTARY PRIMARY
CARE AT A REFUGEE CENTER IN AFRICA,

IT’S ALSO DIFFERENT FROM JOINING OTHER COLLEAGUES TO CHECK
UP ON A HEPATITIS OUTBREAK IN YOUR COMMUNITY.

LET’S FACE THIS ONE SQUARELY: NO OTHER CONTEMPORARY DISEASE
CONDITION IS AT ONCE SO THREATENING AND SO DISTURBING.

* AIDS CAN KILL YOU -- WE KNOW THAT -- IF YOU DO NOT
FOLLOW A FEW SIMPLE BUT VITAL RULES OF HYGIENE AND BARRIER
PROTECTION,
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* AIDS MAKES YOU RECOGNIZE SEXUAL PREFERENCES AND OTHER
PRACTICES WITH WHICH YOU MAY HAVE ABSOLUTELY NO SYMPATHY.
YOU SENSE THAT, ALSO. AND IT CAN MAKE YOU VERY
UNCOMFORTABLE.

* AIDS ASKS ALL OF US TO EXTEND COMPASSIONATE MEDICAL
SERVICE TO INDIVIDUALS WHOSE LIVES ARE A LETHAL MIXTURE OF
DRUG ADDICTION AND SOCIOPATHY. THAT MAY ALSO ANGER US AND,
YES, SCARE US, TOO.

THAT'S WHY, WHEN I TELL AUDIENCES THAT “MEDICINE IS ON THE
FRONT LINE OF AIDS,” I REALLY MEAN IT. WE’RE SEEING THE DISEASE
“UP CLOSE AND PERSONAL,” AS MY FRIENDS IN TELEVISION WOULD SAY,

BUT THAT’S BEEN OUR ROLE FOR CENTURIES -- 20 TO 30 CENTURIES
AT THE VERY LEAST -- AND IT WILL CONTINUE TO BE OUR ROLE FOR THIS
AND SUBSEQUENT CENTURIES AS WELL.
19
I’M SPENDING A LOT OF TIME ON THIS PART OF MY PRESENTATION

TODAY BECAUSE, TO BE PERFECTLY HONEST ABOUT IT, THIS IS WHAT IS
REALLY CONCERNING ME THESE DAYS: THAT IS, THE DEGREE TO WHICH
THE MEN AND WOMEN OF MEDICINE ARE -- AND WILL CONTINUE TO BE --
COMMITTED TO ACTIVELY FULFILLING THEIR PROFESSIONAL OATHS AND
COMMITMENTS,

WE READ THESE OCCASIONAL ARTICLES ABOUT FRAUD IN RESEARCH
+++ ABOUT OVER-CHARGES FOR MEDICARE OR MEDICAID SERVICES ...
ABOUT PHYSICIANS AND CLINICS TURNING AWAY AIDS PATIENTS AND WE
ARE QUTRAGED.

I DON’T FOR ONE MOMENT BELIEVE THAT THOSE STORIES REFLECT
THE TYPICAL BEHAVIOR OF THE AVERAGE FAMILY PHYSICIAN OR
BIOMEDICAL RESEARCHER OR NURSE OR DENTIST OR WHOMEVER,

BUT NEITHER WILL I DISMISS THEM AS STORIES TOO INCONSE-
QUENTIAL TO CONCERN ME. THEY DO GENUINELY CONCERN ME, AS THEY
MUST CONCERN YOU, ALSO. JUST ONE INCIDENT OF A PHYSICIAN DENYING
CARE TO JUST ONE AIDS PATIENT IS ... ONE INCIDENT TOO MANY.
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LET ME SAY THAT THE TRADITION OF AMERICAN PUBLIC HEALTH IS
TO FIGHT DISEASE ... NOT TO FIGHT THE PEOPLE WHO HAVE IT ... OR
PEOPLE WE THINK MIGHT HAVE IT.

AMERICA HAS TAKEN ON SOME PRETTY DIFFICULT DISEASES OVER THE
YEARS -- SMALLPOX, POLIO, LEPROSY, MEASLES, SYPHILIS -- BUT IN
NOT ONE OF THOSE CASES DID WE ATTACK THE PEOPLE WHO WERE SICK ...
JUST THE SICKNESS ITSELF.

AND I CAN ASSURE YOU, AS YOUR SURGEON GENERAL, WE’RE NOT
GOING TO CHANGE NOW ... AIDS OR NO AIDS

BUT I’M NOT GOING TO BE YOUR SURGEON GENERAL FOREVER. MY
TERM WILL RUN OUT NEXT YEAR SO, FOR ALL INTENTS AND PURPOSES,
THIS IS PROBABLY MY FAREWELL APPEARANCE. AND I’D LIKE TO LEAVE
YOU WITH A REQUEST -- A “CHARGE,” IF YOU WILL -- AND IT IS THIS:
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USE THIS CURRENT PLAGUE OF AIDS AS A TOUCHSTONE OF

CONTEMPORARY MEDICAL PRACTICE. FIGHT THIS TERRIBLE DISEASE,
BUT DO SO IN LEAGUE WITH MILLIONS OF OTHER HEALTH
PROFESSIONALS HERE AND AROUND THE WORLD, AND USE THOSE TWO
POWERFUL PUBLIC HEALTH WEAPONS THAT ARE AT HAND: EDUCATION
AND COMPASSIONATE CARE.

I HOPE EACH OF YOU WILL RESPOND TO THIS CALL. I KNOW YOU HAVE
THE TRAINING AND EXPERIENCE AND PERSONAL COMMITMENT TO DO SO. I
HOPE YOU DO,

AND, WHETHER IN OR OUT OF THIS UNIFORM, I CAN ASSURE YOU
THAT I‘LL BE WATCHING -- ALONG WITH ALL OTHER AMERICANS -- WITH
GREAT ADMIRATION AND DEEP APPRECIATION FOR A LIFE-SAVING JOB
“WELL DONE.”

THANK YOU,
HHH #